điều kiện là một multifocal chứ không phải là một động kinh hoàn toàn chẩm. Đánh giá chẩn đoán và chẩn đoán sai. Hội chứng Panayiotopoulos là thường xuyên bị nhầm lẫn với các rối loạn nonepileptic và đôi khi cho các loại động kinh. Điều này phản ánh ictal bất thường đặc điểm lâm sàng và | 23 BENIGN FOCAL EPILEPSIES OF CHILDHOOD 345 the condition being a multifocal rather than a purely occipital epilepsy. Diagnostic Evaluation and Differential Diagnosis. Panayi-otopoulos syndrome is frequently mistaken for nonepileptic disorders and occasionally for other types of epilepsy. This reflects its unusual ictal clinical features and for a benign epilepsy its somewhat unusual interictal EEG features. Because of the prolonged nature of seizures in Pan-ayiotopoulos syndrome many children present with it to emergency departments while they are still in an ictal state. However if the main features of this are impaired consciousness and vomiting an epileptic state may not even come into the differential diagnosis. Conditions such as encephalitis and meningitis are often considered. If the ictus terminates in a hemi- or generalized convulsion this may merely strengthen the presumptive but erroneous diagnosis. Many such children end up intubated and treated in pediatric intensive care units with antibiotics and antiviral agents. The prolonged seizures of Panayioto-poulos syndrome may also be confused with acute confu-sional migraine and if vomiting is particularly prominent with cyclical vomiting syndrome or gastroenteritis. Some seizures may simply be dismissed as travel sickness. The EEG of Panayiotopoulos syndrome may be similar or identical to that of idiopathic childhood occipital epilepsy or rolandic epilepsy and these conditions may be mistakenly diagnosed if the clinical history is ignored 74 . More importantly multifocal spike discharges and cloned-like repetitive multifocal spike wave complexes may suggest more malignant epilepsies such as the Lennox-Gastaut syndrome although clinically these conditions are completely different. Unlike the other conditions described in this chapter children with Panayiotopoulos syndrome commonly present to emergency departments while still seizing or in the immediate postictal period. Panayiotopoulos syndrome should be .
